Seppälä B, Sorsa T, Ainamo J
Institute of Dentistry, University of Helsinki, Finland.
J Periodontol. 1997 Dec;68(12):1237-45. doi: 10.1902/jop.1997.68.12.1237.
This study examined cellular and vascular changes in gingival connective tissue samples by stereologic point-counting procedures and interactive digital analyzing systems in long-term insulin-dependent diabetes mellitus patients. Gingival connective tissue capillaries representing a clinically healthy sulcus with no evidence of periodontal disease at the site of biopsy were studied in 29 patients with diabetes. Based upon their long-term medical records, 19 were identified as having poorly controlled (PIDD) and 10 as controlled insulin-dependent diabetes mellitus (CIDD). Ten nondiabetic, age- and gender-matched individuals served as controls. Thirty-nine biopsies were processed for light microscopy, and the blood vessel area was analyzed using an interactive digital analyzing system; 9 gingival biopsies, 5 diabetic and 4 controls, were processed for morphometric electron microscopic analysis. For each individual, site-specific recordings were made for the plaque index, bleeding index, probing depth, loss of attachment, and radiographic loss of interproximal alveolar bone. No evident signs of periodontitis occurred at the biopsy sites. For each PIDD patient, respective volumetric and numeric densities of cellular components including fibroblasts, neutrophilic granulocytes, monocyte/macrophages, mast cells, lymphocytes, blast cells, and plasma cells were recorded in the inflamed connective tissue (ICT). Non-cellular components such as collagen fibers and blood vessels were also recorded. PIDD patients had elevated plasma cell levels relative to controls and they appeared also to have a decreased collagen fiber density. In addition, fibroblasts occupied less volume in the ICT of PIDD patients than in controls. PIDD patients had the largest mean area of cross-section of the blood vessels, but this difference was not statistically significant (P > or = 0.211; t-test). No specific characteristics of ICT or vascular changes were detectable in adult well-controlled long-term diabetics under similar plaque conditions. Swollen and proliferated endothelial cells were frequently found in PIDD patients and the mean distance from the lumen to the outer border of basement membrane was greater in the PIDD than in the controls (P < 0.001; t-test). Overall, our findings that cellular, vascular, and connective tissue changes indicative of increased catabolism rather than anabolism detected in gingiva are especially associated with poorly controlled long-term insulin-dependent diabetes.
本研究通过体视学点计数法和交互式数字分析系统，对长期胰岛素依赖型糖尿病患者牙龈结缔组织样本中的细胞和血管变化进行了检测。在29例糖尿病患者中，研究了代表临床健康龈沟且活检部位无牙周疾病证据的牙龈结缔组织毛细血管。根据他们的长期病历，19例被确定为控制不佳的胰岛素依赖型糖尿病（PIDD）患者，10例为控制良好的胰岛素依赖型糖尿病（CIDD）患者。10名年龄和性别匹配的非糖尿病个体作为对照。对39份活检样本进行光镜检查，并使用交互式数字分析系统分析血管面积；对9份牙龈活检样本（5例糖尿病患者和4例对照）进行形态计量学电子显微镜分析。对每个个体记录特定部位的菌斑指数、出血指数、探诊深度、附着丧失和邻面牙槽骨的影像学丧失情况。活检部位未出现明显的牙周炎体征。对每位PIDD患者，在炎症结缔组织（ICT）中记录包括成纤维细胞、中性粒细胞、单核细胞/巨噬细胞、肥大细胞、淋巴细胞、母细胞和浆细胞在内的细胞成分的相应体积密度和数量密度。还记录了胶原纤维和血管等非细胞成分。与对照组相比，PIDD患者的浆细胞水平升高，且胶原纤维密度似乎也降低。此外，PIDD患者ICT中成纤维细胞所占体积比对照组小。PIDD患者血管的平均横截面积最大，但这种差异无统计学意义（P≥0.211；t检验）。在类似菌斑条件下，成年控制良好的长期糖尿病患者未检测到ICT或血管变化的特定特征。PIDD患者中经常发现内皮细胞肿胀和增殖，且PIDD患者从管腔到基底膜外边界的平均距离大于对照组（P<0.001；t检验）。总体而言，我们的研究结果表明，牙龈中检测到的指示分解代谢而非合成代谢增加的细胞、血管和结缔组织变化尤其与控制不佳的长期胰岛素依赖型糖尿病相关。
